Challenges in the clinical and radiological differential diagnosis of cerebrovascular events and malignant primary brain tumors: reports from a retrospective case series

AIM: To reveal difficulties in differential diagnosis of some cases of cerebrovascular events (CVEs) and malignant primary brain tumors (MBTs) even a multidiciplinary evaluation in grand rounds. MATERIAL and METHODS: This study retrospectively analyzed the patient archives from January 2017–December 2019. The records of 572 patients discussed in these meetings were examined. A total of 8 patients having a challenge in differential diagnosis were detected. RESULTS: This study has included 8 cases in which neurology−neurosurgery−neuroradiology clinicians have difficulty in differentiating CVE and MBT. In the present study, three patients were evaluated with a preliminary diagnosis of hemorrhagic CVE in the emergency room. Since degradation products of hemoglobin have prevented advanced imaging methods to diagnose in two patients, these patients have been followed closely. The correct diagnosis could be made through the scan performed during control follow-ups The preliminary diagnosis of seven patients was CVE, but they received the MBT diagnosis during the follow-up. One patient was thought to have MBT initially; however, he/she was diagnosed with CVE after an advanced examination and close follow-up. CONCLUSION: Despite developing medical imaging methods and diagnostic studies, there are still some difficulties in making differential diagnosis of CVEs and MBTs. In some patients, further examination and imaging methods may be needed such as magnetic resonance imaging-spectroscopy (MRI-S), perfusion magnetic resonance imaging (Per-MRI), digital substratioangiography (DSA). Despite all these neuroradiological examinations and multidiciplinary evaluation, distinction between CVE and MBT may be difficult, and medicolegal problems may be encountered

Penetrating transorbital intracranial foreign body

Yedi yaşında erkek çocuk, sol gözüne sanayi tipi dikiş makinesi iğnesinin batması şikayeti ile acil servise getirildi. Dikiş iğnesi sol orbitadan girerek sfenoid kemiği delmiş ve sol temporal lobun dura yaprakları içine uzanmaktaydı. Cerrahi tedavi uygulanan olguda ameliyat sonrası dönemde komplikasyon oluşmadı. Orbitadan girerek beyine kadar uzanan penetran yabancı cisimler intraserebral hematom, beyin apsesi, menenjit, beyin omurilik sıvısı (BOS) fistülü, proptosis, diplopi, orbital sellülit ve periorbital apse gibi komplikasyonlara neden olabilirler. Bu komplikasyonları önlemek için penetran transorbital uzanımlı yabancı cisimler cerrahi yaklaşımla çıkartılmalıdır.We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications

A case of superior sagittal sinus thrombosis after closed head injury

Süperior sagittal sinüs trombozu (SSST) nadir görülen bir hastalıktır. Genellikle enfeksiyon, dehidratasyon ve hematolojik rahatsızlıklara bağlı gelişir. Travmaya bağlı gelişmesi son derece nadir bir durumdur. Bu yazıda kapalı kafa travması sonrası SSST saptanan 13 yaşında bir erkek çocuk hasta sunuldu. Görüntüleme incelemelerinde çökme kırığına bağlı gelişen SSST saptandı. Hastanın nörolojik muayenesi iki taraflı papil stazı dışında normal bulundu; hasta anti-ödem ve antikonvülzan ilaçlarla tedavi edildi. Sekiz ay sonraki kranyal manyetik rezonans venografide süperior sagittal sinüsün açık olduğu izlendi ve nörolojik muayene bulguları normal olarak değerlendirildi.Superior sagittal sinus thrombosis (SSST) is a rare entity, most often arising from infections, dehydration, and hematologic disorders. Development of this condition secondary to trauma is extremely rare. In this report, a 13-year-old boy who developed SSST following a closed head injury is presented. Imaging studies showed SSST caused by a depressed skull fracture. Neurologic examination of the patient was normal other than bilateral papillary stasis. He was treated with antiedematous and anticonvulsant drugs. Magnetic resonance venography obtained eight months after the diagnosis showed unoccluded superior sagittal sinus, neurologic examination findings were normal, as well

Eklem Hastalıkları ve Cerrahisi Joint Diseases and Related Surgery Case Report / Olgu Sunumu Solitary spinous process metastasis: a case report Soliter spinöz çıkıntı metastazı: Olgu sunumu

Primary malignant tumors frequently metastasize to bone, third in frequency after liver and lung. [2] Breast and prostate cancers have particular clinical interest because of the prevalence of these diseases, with about 70% of the patients dying of these cancers having evidence of metastatic bone disease. [3] Bone metastases are also seen in carcinomas of the thyroid, kidney, and bronchus with an incidence of 30-40% at postmortem examination. [3] However, tumors of the gastrointestinal tract rarely (<10%) metastasize to the bone. Anahtar sözcükler: Kemik dokusu; bel ağrısı; neoplazm metastazı; neoplazmlar; omurga. Vertebral column is a common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors usually present with pain. Some tumors are asymptomatic and can be detected during screening examinations. Magnetic resonance imaging (MRI) of the vertebral column with the panel of available imagining methods and the clinical findings should be used for the diagnosis of spinal metastasis. A 45-year-old man was admitted with low back pain. With a history of rectum surgery and radiotherapy, he was on chemotherapy for rectum adenocarcinoma. F18 sodium fluoride positron emission tomography scan which was performed three weeks ago showed no abnormalities other than the primary surgical site. Magnetic resonance imaging of the lumbar vertebrae spine revealed a lesion on the tip of L4 spinous process. Excisional biopsy of L4 spinous process was performed. Histologic examination revealed mucinous adenocarcinoma. He had no low back pain at two-months follow-up. We could not find any solitary spinous process metastasis reported in English literature. Patients with nonspecific spinal pain with a previous cancer history should be carefully evaluated for a spinal metastasis. Even a solitary spinous process lesion may turn out to be the initial manifestation of a spinal metastasis

Ateşli silah yaralanmasına bağlı spinal aksesuar sinir palsi: olgu sunumu

Spinal aksesuar sinir yaralanmalar› seyrek görülür ve ço¤unlukla iyatrojeniktir. A¤r›, ayn› taraf omuzun kald›r›lmas› nda güçlük ve kol abdüksiyonunda skapular kanatlanma, en s›kl›kla görülen klinik bulgulard›r. Ender rastlanan bir olgu olmas› nedeniyle, 20 yafl›nda, ateflli silaha ba¤l› penetran yaralanma sonras›nda spinal aksesuar sinir palsili bir erkek olgu sunuldu. Yaralanmadan üç ay sonra, sol kolunu omuz hizas›na kadar abdüksiyona getirdi¤inde a¤r› ve harekette k›s›tl›l›ktan flikayetçiydi. Fiziksel incelemesinde sol trapez kas› erimifl ve omuzu düflmüfl flekildeydi. Nörolojik incelemede sol trapez ve sternokleidomastoid kaslar›n›n motor fonksiyonlar› 3/5 idi; boyun, omuz ve kolda yayg›n dizestezi vard›. Mermi, klavikulan› n üzerinden girip, trapez kas›ndan ç›km›flt›. Radyolojik incelemeler normaldi fakat elektromiyelografi’de (EMG) nöropatik de¤ifliklikler saptand›. Cerrahi eksplorasyonda sinirin trasesi boyunca do¤al seyirini izledi¤i görüldü ve dekompresyon amaçl› eksternal nörolizis yap›ld›. Ameliyat sonras› sorunsuz geçti. Dizestezi ilerleyen günlerde kayboldu. Fizik tedavi de uygulanan hastan›n üç ay sonraki kontrol muayenesinde motor fonksiyonlar 4/5 idi ve EMG’de sol spinal aksesuar sinirde iyileflme saptand›.Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natural course and we performed external neurolysis for decompression. The postoperative period was uneventful.Dysesthesia has diminished slowly. He was transferred to physical rehabilitation unit. In his clinical control after 3 months he had no dysesthesia and neurological examination of the left trapezius and sternomastoid muscles motor function were 4/5. EMG showed recovery in the left spinal accessory nerve

A new method of patient's head positioning in suboccipital retrosigmoid approach

Background: The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient′s head positioning just before the operation is crucial to perform the procedure effectively and safely. Aim : The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI). Materials and Methods : The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured. Results : This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain. Conclusions : This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side

Analysis of proximal radial nerve injury in the arm

Background: Radial nerve is the most frequently injured major nerve in the upper extremity. Proximal part of the radial nerve involvement can result from a humerus fracture, direct nerve trauma, compression and rarely from tumors. Objectives: The aim of the study is to determine the clinical characteristics and electrodiagnostic findings in patients with proximal radial nerve injuries, and also the outcome of surgical treatment. Materials and Methods: The study subjects included 46 patients with radial nerve injuries seen between June 2000 and June 2008 at our hospital. The analysis included demographics, clinical features, etiology, pre-and postoperative EMNG (Electromyoneurography) findings. Results: Surgical decompression resulted in neurological improvement in patients with radial entrapment neuropathies. Good neurological recovery was observed from decompression of callus of old humeral fracture. The worst results were observed in the direct missile injuries of the radial nerve. Conclusions: A detailed clinical and electrodiagnostic evaluation is of importance in patients with radial nerve injury to ensure an appropriate treatment. The choice of treatment, conservative or surgical, depends on the clinical presentation and the type of injury

Brucelozowe zapalenie krążka międzykręgowego jako przyczyna wypadnięcia krążka w odcinku lędźwiowym – opis przypadku

Abstract Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.Streszczenie Bruceloza to choroba zakaxna przenoszona przez spożycie niepasteryzowanych produktów mlecznych lub przez kontakt z zakażonym zwierzęciem. Zajęcie kręgosłupa jest jednym z najistotniejszych jej powikłań, a odcinek lędźwiowy to okolica najczęściej objęta zmianami chorobowymi. Uciśnięcie korzenia nerwowego jest jednym z neurologicznych następstw choroby i może być spowodowane ropniem nadtwardówkowym, ziarniniakiem lub zapaleniem krążka międzykręgowego wtórnym do zajęcia trzonu kręgu. Przedstawiono przypadek 50-letniego mężczyzny, u którego brucelozowe zapalenie krążka międzykręgowego bez zapalenia kręgu spowodowało wypadnięcie krążka międzykręgowego w odcinku lędxwiowym. Autorzy podkreślają, że zapalenie krążka międzykręgowego należy brać pod uwagę w rozpoznaniu różnicowym przyczyn uciśnięcia korzenia nerwowego

Sorafenib and lithium chloride combination treatment shows promising synergistic effects in human glioblastoma multiforme cells in vitro

Objectives: The objectives of this study were to test the effects of the new combination treatment modality, sorafenib (SOR) and lithium chloride (LiCl) and to assess whether midkine (MK) protein has a role in any potential effects